Mumps — formative SAQs

SAQ 1 (10 marks)

A 16-year-old boy presents with three days of fever, malaise and progressive bilateral tender parotid swelling, and today with severe right testicular pain and swelling. He received two MMR doses as a child and has just started university, where a mumps outbreak is circulating. On examination the right testis is swollen and tender; the parotid swelling is classic. ^[5]

Question: Outline the immediate and stepwise management of this adolescent, including the acute scrotal-pain assessment, supportive care, diagnosis, infection control and the public-health response. (10 marks) ^[4]

Model answer

Acute scrotal-pain assessment (2 marks). The immediate priority is to exclude testicular torsion, a time-critical surgical emergency, because mumps orchitis and torsion can overlap. The history (sudden onset, severe pain, absent cremasteric reflex, high-riding testis) and the timing relative to parotitis matter, but whenever torsion is plausible the safest stance is urgent surgical assessment rather than attributing the pain to mumps. Torsion missed is devastating and avoidable. ^[5]

Diagnosis (2 marks). Send a buccal or oral swab for mumps RT-PCR, which has its highest yield in the first one to three days of parotitis, and supplement with mumps IgM and IgG serology. In a previously vaccinated individual IgM may be blunted, so PCR with genotyping (to confirm wild-type rather than vaccine strain) is the most informative approach. Do not delay supportive care or isolation while waiting for results. ^[6]

Supportive care (2 marks). There is no antiviral, antibiotic or corticosteroid of proven benefit in mumps; management is supportive. Provide analgesia and antipyretics (paracetamol or ibuprofen), hydration, a soft diet that does not stimulate painful salivation, and scrotal support and rest for the orchitis. Admit for pain control if needed, and give honest discussion of testicular atrophy (possible) and sterility (rare). ^[4]

Infection control (2 marks). Isolate with droplet precautions and exclude from university for five days from the onset of parotitis swelling, supported by the Kutty evidence review that justified the change from nine days. The five-day window reflects the sharp fall in infectiousness after the first days of parotitis. ^[3]

Public-health response (2 marks). Notify public health according to local requirements, because mumps is notifiable, and the notification triggers contact tracing and the outbreak-control response. Trace household and close contacts, identify who is susceptible (under-vaccinated, pregnant, immunocompromised), give catch-up MMR to the under-immunised, and — in this outbreak setting — offer a targeted third MMR dose to high-risk groups, for which the Cardemil study provides the evidence base. ^{[1] [2]}